Parinaud's syndrome in aqueduct stenosis: its mechanism and ventriculographic features

Lerner, M. A.; Kosary, I. Z.; Cohen, Bruce E.

doi:10.1259/0007-1285-42-496-310

Cited by 21 publications

(14 citation statements)

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“…The combination of all these signs in one patient is relatively rare, although observed by us among our pa tients [8,11,16]. The syndrome, described in detail by Kestenbaum in 1946, has also been described and dis cussed by many authors in patients with internal hydro cephalus [10,12,15], The most probable pathogenesis of the periaqueduct syndrome is a transependymal imbibi tion with liquor of the adjacent structure and the dilata tion of the third ventricle and aqueduct of Sylvius induc ing disorders in cerebral blood flow in that region [7,10,17], The presence of a concomitant malformation can not be excluded as a possibility [18].…”

Section: Discussionmentioning

confidence: 82%

“…The syndrome, described in detail by Kestenbaum in 1946, has also been described and dis cussed by many authors in patients with internal hydro cephalus [10,12,15], The most probable pathogenesis of the periaqueduct syndrome is a transependymal imbibi tion with liquor of the adjacent structure and the dilata tion of the third ventricle and aqueduct of Sylvius induc ing disorders in cerebral blood flow in that region [7,10,17], The presence of a concomitant malformation can not be excluded as a possibility [18]. The occurrence of this syndrome is most often a manifestation of a sharp elevation of the ventricular pressure, particularly in dis turbed function of the shunt, which according to some authors is an indication for urgent surgical treatment [12,15,17], The occurrence of such symptoms could be explained with transitory changes in the ventricular pres sure [5,19], Papilledema is the most frequently discussed mani festation in the hydrocephalic-hypertensive syndrome, with the generally accepted opinion that its manifesta tion is adequate to the extent of the internal hydroceph alus [4], The exceptionally great clinical significance of this symptom is confirmed by the numerous attempts made at elucidating its pathogenesis on clinical and experimental material [8,11,20,21], The direct link between the state of the anterior fontanelle and the extent of the lesion on the optic nerve is underlined by a great many authors [11,14,16,22]. The pathogenetic mechanisms leading to the optic atrophy in the optic nerve are discussed in various sources of the literaturepreceding papillary edema, direct compression, isch emia, disturbed cerebral hemodynamics, and elevated pressure in the central retinal artery [21,[23][24][25].…”

Section: Discussionmentioning

confidence: 99%

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Neuroophthalmological Symptoms in Children Treated for Internal Hydrocephalus

Tzekov¹,

Cherninkova²,

Gudeva³

1991

Pediatr Neurosurg

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The object of the study are 126 children with internal hydrocephalus treated within the period 1978–1990. The children were preoperatively divided into six groups according to the etiology of the hydrocephalus. Disorders of the visual functions accompanying elevated intracranial pressure (setting sun 51, syndrome of the aqueduct of Sylvius 14, paresis of craniocerebral nerves 9, nystagmus 8, optic atrophy 4) were established preoperatively in 48.4% of the children. 44 of the children were revised because of malfunction of the shunt with the following neuroophthalmological symptoms: setting sun 6, paresis of craniocerebral nerves 9, syndrome of the Sylvius aqueduct 6, papilledema 6, optic atrophy 9 and nystagmus 5. The fact that a great many changes in the visual functions sometimes precede the manifestations of the changes in CT image determines their significance for early diagnosis and treatment.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Neuroophthalmological Symptoms in Children Treated for Internal Hydrocephalus

Tzekov¹,

Cherninkova²,

Gudeva³

1991

Pediatr Neurosurg

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“…Lerner ά col. 7 descrevem situação similar, chamando a atenção para a importância da identificação da porção posterior do III ventriculo e das estruturas mesencefálicas. Shallat & col. ,4 , mais recentemente, estudam quatro pacientes com SP e hipertensão endocraniana, secundárias e hidrocéfalo obstrutivo não tumoral: em dois casos foi indicada radioterapia após derivação liquórica, diante da possibilidade de tumor da região pineal.…”

Section: Comentáriosunclassified

Sindrome de Parinaud indicando hidrocefalo descompensado em pacientes com derivação liquórica

Ferreira

Brandalise²

1978

Arq. Neuro-Psiquiatr.

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A paralisia do olhar conjugado no plano vertical, associado ou não a alterações pupilares, conhecida como síndrome de Parinaud (SP) 17 , tem sido considerada, especialmente em comunicações neurocirúrgicas, como sinal patognomômico de tumor da região pineal ou da porção posterior do 111 ventrículo 3,5,ιι,ΐ8 β Esse conceito levou alguns autores a indicar radioterapia em pacientes com hipertensão endocraniana e SP, após a realização de derivação liquórica 14 . Poucos relatos salientam a correlação da SP com obstruções liquó-ricas devidas a hidrocéfalo hipertensivo não tumoral 2 » e » 7 » 14 .A presente comunicação se prende ao estudo de dois pacientes, com hidrocéfalo secundário à estenose não tumoral de aqueduto, que apresentaram, no curso de sua doença, paralisia da elevação ocular. OBSERVAÇÕESCaso 1 -O.V.K., sexo masculino, branco, 22 anos, internado em 28-12-76 (Reg. n? 16.461), por apresentar cefaléia, com períodos de acalmia, desde há dois anos. A cefaléia ocorre mais à noite, com localização bifrontal e em capacete, de grande intensidade, que cede com analgésicos.Nesse período apresentou, por quatro vezes, dor abdominal seguida de inconsciência, dificuldade respiratória, pupilas mióticas, sinal de Babinski à esquerda e ulterior agitação psicomotora.Exame clinico-neurológico -Edema de papila bilateral, mais intenso à esquerda, como o único achado anormal. Raio X de crânio: sinais indiretos de hipertensão endocraniana. Angiografia carotidea: sinais indiretos de dilataç&o do sistema ventricular. Ventriculografia seletiva com Dimer X: dilataçao significativa do III ventriculo e do recesso suprapineal, estenose do aqueduto de Silvius, hérnia intrasselar do III ventriculo (Fig. 1). Ato operatório (6-1-77): derivação ventrículo-peritoneal com válvula tipo Puienz e cateter peritoneal tipo Raimondi de média pressão, manufaturado por Mafra. Reinternação,em 4-2-77, por apresentar cefaléia, vômitos, agitação psicomotora e sonolência, A punção do reservatório subcutaneo do sistema de derivação, com retirada de 30 ml de liquido cefalorraqueano (LCR) normal, propiciou melhora clinica. O bombeamento do reservatório dava a impressão de funcionamento normal da derivação. Em um lapso de 25 dias, foram feitas cinco punções do reservatório com retirada de 30 ml de LCR de cada vez, que foram seguidas de melhora clinica e ulterior piora. Durante as fases de piora o paciente apresentava os mesmos sintomas que motivaram

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“…) aqueductal stenosis who had paralysis of upward gaze and pupillary abnormalities. Subsequently, there have been isolated case reports of upward gaze paralysis occurring in hydrocephalus, mostly of later onset (Globus and Bergman, 1946;case 1;Beckett et al, 1950, case 8;Cassinari et al, 1963;Nag and Falconer, 1966, case 8;Lerner et al, 1969;Jerva and Nelson, 1971;Shallat et al, 1973;and Swash, 1974); however, this reported association has not found its way into the leading textbooks of neuro-ophthalmology of Kestenbaum (1946), Cogan (1956), and Walsh and Hoyt (1969) and the review articles of Holmes (1921), Smith et al, (1959), Segarra and Ojeman (1961), and Hatcher and Klintworth (1966).…”

mentioning

confidence: 99%

“…Cassinari et al (1963), Walsh and Hoyt (1969), and recently Swash (1974) also postulated dilatation of the third ventricle and rostral aqueduct as the possible mechanism for upward gaze palsy observed in hydrocephalus. However, Lerner et al (1969), Jerva and Nelson (1971), and recently Shallat et al (1973) have postulated compression of the tectal and pretectal region from the distended suprapineal recess as the possible mechanism. The presence of other features of the Sylvian aqueduct syndrome along with upward gaze palsy in several of our cases would suggest periaqueductal dysfunction rather than the compression of the tectal region.…”

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confidence: 99%

Sylvian aqueduct syndrome as a sign of acute obstructive hydrocephalus in children.

Chattha¹,

DeLong²

1975

Journal of Neurology, Neurosurgery & Psychiatry

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SYNOPSIS Eight cases of obstructive hydrocephalus manifesting palsy of upward gaze and other features of the Sylvian aqueduct syndrome are reported. During the crisis of intracranial hypertension, all of them developed upward gaze palsy and variable abnormalities of the convergence mechanism such as paralysis, spasm, and convergence nystagmus. The frequent apparent blindness was probably related to gaze paralysis, since visual evoked responses were present. All these ocular abnormalities disappeared after shunting. Periaqueductal dysfunction on the basis of raised intracranial pressure is postulated as the possible mechanism for the above ocular manifestations. The ' setting sun' sign is frequently seen in infants and children with hydrocephalus and has been considered in the past to result from displacement of eyeballs by pressure from the orbital roof plate. Our observations would suggest periaqueductal dysfunction rather than the mechanical displacement as the possible mechanism for this sign.

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Parinaud's syndrome in aqueduct stenosis: its mechanism and ventriculographic features

Cited by 21 publications

References 3 publications

Neuroophthalmological Symptoms in Children Treated for Internal Hydrocephalus

Neuroophthalmological Symptoms in Children Treated for Internal Hydrocephalus

Sindrome de Parinaud indicando hidrocefalo descompensado em pacientes com derivação liquórica

Sylvian aqueduct syndrome as a sign of acute obstructive hydrocephalus in children.

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